Provider Demographics
NPI:1235463118
Name:BATES, JEFFERY PAUL (BA, JD)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:PAUL
Last Name:BATES
Suffix:
Gender:M
Credentials:BA, JD
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Mailing Address - Street 1:215 THACH LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-1625
Mailing Address - Country:US
Mailing Address - Phone:256-829-5430
Mailing Address - Fax:931-393-5902
Practice Address - Street 1:709 DAVIDSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3607
Practice Address - Country:US
Practice Address - Phone:931-461-1349
Practice Address - Fax:931-393-5902
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical